Outcomes of Repeat Endoscopic Retrograde Cholangiopancreatography Following Initial Unsuccessful Cannulation: A...

Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used to treat pancreaticobiliary diseases, but can be technically challenging, leading to occasional unsuccessful attempts. While repeat ERCP is one option in these cases, data on the effectiveness and safety of this practice remain limited. Thus, we conducted a systematic review and meta-analysis to assess outcomes of repeat ERCP after initial unsuccessful attempt.

MEDLINE, Embase, and CENTRAL were searched on February 28, 2025. We included randomized trials and observational studies reporting on outcomes of repeat ERCP following an initial unsuccessful attempt, with the primary outcome being technical success of cannulation, and secondary outcomes including adverse events (AEs). Random-effects models were used to pool data, and heterogeneity was assessed through the I² statistic.

A total of 22 studies involving 1514 patients with a median age of 62 years were included. The majority of studies were conducted at a single center (86.4%), where the most common indication for repeat ERCP was choledocholithiasis (41.2%), followed by malignant biliary obstruction (29.0%). The pooled technical success rate of repeat ERCP was 83.6% (95% CI 78.6-88.1%, I² = 76.4%). The pooled AE overall rate was 7.3% (95% CI 5.2-9.6%, I² = 27.5%), with pancreatitis being the most frequent and with this overall AE rate being statistically comparable to that associated with patients' index ERCPs.

Our meta-analysis demonstrated encouraging success rates with repeat ERCP after initial failure, with acceptably low AE rates, highlighting its role as a primary option in cases of initial unsuccessful ERCP.